Headache in the elderly

Aging is accompanied by a decline in the incidence of most primary headache disorders and an increase in the incidence of organic causes of headache. Headaches that begin after age 55 are more often due to serious conditions, or are exacerbated by comorbid disorders. When evaluating the older patient with new onset headache or a change in headache pattern, one must rule out serious secondary causes of headache, such as tumor, subdural hematoma, stroke, transient ischemic attack, and temporal arteritis. When older patients present with headache, a lowered threshold for ordering tests is justified, particularly if the headaches are of recent onset, are atypical, or are associated with neurologic findings. This article discusses the secondary causes of headache in the elderly and the symptoms and appropriate testing and treatment of these headaches. The epidemiology and treatment of the primary headache disorders in the elderly are reviewed.